Considerations of infections on boats.

Here is a new report describing V cholerae (several species in the Vibrio genus) non serotype O1 and O139 outbreak in South Carolina linked to seafood. We investigated an outbreak a couple years ago and toxigenic V cholerae serotype O75 was the causative agent. CDC did the typing and toxin testing and expect they will perform testing on these isolates


CHOLERA - USA: (SOUTH CAROLINA) PROBABLE NON-O1, NON-O139
*********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 16 Oct 2013
Source: FOX Carolina [edited]
<http://www.foxcarolina.com/story/23711212/dhec-shellfish-illness-sickens-sc-residents>


Officials are warning the public after 3 people in South Carolina
became ill from eating shellfish. The South Carolina Department of
Health and Environmental Control [DHEC] said on Wednesday, 16 Oct
2013, that the 3 people have confirmed cases. DHEC said the bacterium
causes gastroenteritis, not cholera.

"We are working with the FDA and many partners to identify the source
of the contaminated shellfish," said Linda Bell, MD and state
epidemiologist. "We are informing healthcare providers of the
situation and will continue to monitor the state for additional
cases."

DHEC said there is no evidence the contaminated shellfish originated
in South Carolina waters.

They said the symptoms of _Vibrio cholerae_ include nausea, vomiting
and diarrhea that begin from a few hours to up to 5 days after
consumption of raw shellfish. The infection is usually mild or without
symptoms, but can occasionally be severe. In severe cases, an infected
person may experience profuse watery diarrhea and vomiting that can
cause dehydration and shock, DHEC said.

"The elderly, young and immunocompromised are particularly at risk of
developing illness from consuming raw shellfish," said Bell. "The best
way to protect yourself and your family from getting ill is to
thoroughly cook all shellfish before eating."

[Byline: Joseph Pereira]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Given the statement that the infections were "not cholera," the
organisms identified in the SC cases were likely non-epidemic strains
of _Vibrio cholerae_ that were non-O1 and non O-139 isolates. Overall,
non-O1, non-O139 strains of _V. cholerae_ tend to (but not always)
cause milder gastrointestinal illness and also can have bacteremic,
non-diarrhea presentations.

In almost all cases, non-O1, non-O139 _V. cholerae_ isolates do not
possess the genes for either cholera toxin or the toxin-coregulated
pilus (TCP). Yet, some isolates can cause substantial diarrhea (1-4).
The type III secretion system (TTSS) is a mechanism for Gram negative
bacilli to introduce effector proteins into host cell cytoplasm (5).
It has been reported that a functional TTSS is required for at least
some non-O1, non-O139 isolates to induce diarrhea in an animal model
associated with small bowel damage and production of proinflammatory
cytokines (6). In addition, TTSS contributes to virulence even in the
presence of cholera toxin and TCP (6).

References:
1. Bhattacharya MK, Dutta D, Bhattacharya SK, et al. Association of
disease approximating cholera caused by _Vibrio cholerae_ of
serogroups other than O1 and O139. Epidemiol Infect. 1998; 120: 1-5.
2. Sharma C, Thungapathra M, Ghosh A, et al. Molecular analysis of
non-O1, non-O139 _Vibrio cholerae_ associated with an unusual upsurge
in the incidence of cholera-like disease in Calcutta, India. J Clin
Microbiol. 1998; 36: 756-763.
3. Bidinost C, Saka HA, Aliendro O, et al. Virulence factors of
non-O1, non-O139 _Vibrio cholerae_ in Cordoba, Argentina. Rev Argent
Microbiol. 2004; 36: 158-163.
4. Chatterjee SC, Ghosh K, Raychoudhuri A, et al. Incidence, virulence
factors, and clonality among clinical strains of non-O1, non-O139
_Vibrio cholerae_ isolates from hospitalized diarrheal patients in
Kolkata, India. J Clin Microbiol. 2009; 47: 1087-1095.
5. Gatan JE, Colimer A. Type III secretion machines: bacterial devices
for protein delivery into host cells. Science 1999: 284: 1322-1328.
6. Shin OS, Tam VC, Suzuki M, et al. Type III secretion is essential
for the rapidly fatal diarrheal disease caused by non-O1, non-O139
_Vibrio cholerae_. mBio 2(3): e00106-11.doi:0.01128/mBio.00106-11.
- Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/2E*P>.]

[see also:
2011
----
Cholera - USA (05): (NY) non-O1, non-O139 20110706.2046
Cholera - USA: (NY): RFI 20110616.1840
Cholera O75 - USA: (FL) raw oysters, warning 20110511.1443
Cholera - USA (03): (NY) ex Dominican Rep. banquet 20110208.0429
Cholera - USA (02): (MA) ex Dominican Rep. banquet 20110130.0364
Cholera - USA: (MA) ex Dominican Rep., banquet 20110127.0326
2010
----
Cholera - Haiti (21): USA (FL) 2010
 
DHEC said there is no evidence the contaminated shellfish originated
in South Carolina waters.


Too bad they did not trace source of the Oysters. It could be domestic, in one of a number of states, or it could be a foreign source. A few years ago, Calif. (and a few other states) required that any oysters from the Gulf of Mexico, sold in Calif. have a warning label about increased risk for people with compromised immune system. Of course that decreased the sale of Gulf Oysters in Calif--and increased the sale of foreign and Calif. Oysters..
 
Tracebacks are very difficult to perform and takes a lot of time with lots of data showing product items, suppliers, distributors, copies of records, phone calls, conference calls emails, faxes, legal documents, cotnacts of other stats, the Feds, etc then the analysis.
sometimes successful sometimes not
I bet you dollars to donuts that the team investigating this OB is performing a thorough job


A couple of years, we investigated are outbreak of shiga toxin producing E coli non O157 and the epi link was bulk shredded lettuce. Several state labs could not isolate it but the NY State Dept of AG recovered it and performed PFGE (DNA finger printing) and the pattern matched the human cases. The supplier recalled the remaining lots and a performed thorough cleaning and implemented improve HAACP practices.
I estimated 100 people worked on this outbreak
 
BrentB":2afnjio9 said:
Tracebacks are very difficult to perform and takes a lot of time with lots of data showing product items, suppliers, distributors, copies of records, phone calls, conference calls emails, faxes, legal documents, cotnacts of other stats, the Feds, etc then the analysis.
sometimes successful sometimes not

I estimated 100 people worked on this outbreak

..and contributed to the prevention of morbitity and mortality of many thousands, I'll bet. Your tax dollars at work.
 
Marty and his Admiral provided exemplary service at New Jersey State Dept of Health for years and retired in 1999

Best and God Bless you
 
e State of Florida has seen a number of cases in 2013 and I had the opportunity to discuss the situation with Vibrio vulnificus in the Sunshine State with Epidemiologist with the Florida Department of Health in Hillsborough County, Amy Pullman earlier this week.

The interview was aired Saturday, Oct. 26 on the Outbreak News This Week Radio show.

Ms. Pullman updated me with the latest numbers, not only of Vibrio vulnificus in the state and Hillsborough County, but of all Vibrio infections.

Since the Wednesday interview, Florida health officials have reported an additional case of V. vulnificus, bringing the total to 36 cases.

In addition, Pullman pointed out that they are seeing more infections due to saltwater wound exposure this year as opposed to consumption of raw oysters.

She also talked about the pathology of this bacterium, risk factors for serious disease and measures to take to prevent this potentially lethal infection.


http://www.theglobaldispatch.com/florid ... ate-37374/
 
People blame the government for improper food inspection and regulation, but I think there is plenty of blame to go around for issues within the entire food production chain and ultimately to the food preparers and consumers.

Eating any undercooked or raw meat, shellfish, or fish is like playing Russian Roulette. I know that the odds are small of someone becoming ill these days, but these risks are not insignificant. I worry when I see olive oil infused with garlic on a restaurant table. Was it prepared by a culinary trained chef, or a glorified cook who is unfamiliar with how to prevent this concoction from growing botulism? At restaurants, should one order a wedge of iceberg lettuce for a salad, or mixed greens? It could make a big difference.

I worked with mostly educated people in my working life, but found that less than 50 percent of my cohorts washed their hands after using the restroom. This is not an exaggeration. It was the height of ignorance.

Also, I can't tell you how many people I know save antibiotics for bacterial infections, and take one pill -- and only one pill -- at the first sign of a cold. Why do they do this? It is because they are ignorant of the difference between a bacterial and viral infection, and they are ignorant of how systemic antibiotics work to control a bacterial infection. So eventually, these very people who think that a magic pill is a viable substitute for good hygiene or proper food preparation will get a rude awakening as they find our drugs are no longer effective.

Then there is pesticides in fruit. Let's take apples for example. My neighbor used a pesticide on his apples that the manufacturer specifically stated could be applied only twice. He has a friend who is a commercial grower who applies it frequently throughout the season. In my view, I would rather eat an apple with a worm than eating a perfect apple; if the pesticides didn't kill the worm, it has a better chance of being safer for me.

So I grow and preserve a great deal of my own fruits (pears, blueberries, raspberries, cherries, grapes) and some vegetables, ask my meat to be cooked well done in restaurants, avoid raw shellfish, order lettuce wedges when possible (it still carries a risk of systemic, bacterial contamination) and resist that garlic-infused olive oil brought to the table. However, these precautions only mitigate risk. There is always a chance for human error with respect to cross contamination of food.

In my opinion, the country needs to alter its educational system to actually teach our children a few things that will actually help them in life: microbiology, hygiene -- even how one balance's one's checkbook. Perhaps we should look into irradiating our food supply if it can be scientifically proven to be safe. Ultimately, we will all benefit.

Rich
 
Foggy":3a39dq01 said:
Great rant.

We have seen the enemy and it is us.

Had enough? Call Dr Kovorkian II.

Aye.

Aye!

:lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: : :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol:
 
To better understand vibrio infections in Florida i would like to multi year data sets. I need to check their communicable disease reporting rules and number of reportable vibrio cases seems low to me. I dont see any clusters or outbreaks in ProMed or Healthmap and on the surface these cases are sporadic and geographically different locations and factor in high population of Florida, high recretional water activities, seafood consumption, snd other factors these cases might be background cases with deaths which mightbe interesting to know the onset date snd date of medical care. If the period is in days and patient is critically ill when seen then a positive outcome is more difficult

In regards to public health education is very important along with funding which can be low or worse mis spent or managed but my chair our public health system is vibrant and thebest in the world

M2cw
 
Just got back from two weeks fishing the jettys in murrels inlet. This topic was in the fore front of my mind.Being careful I still got spined by fish ,minor cuts on jetty,hook sticks ect. Cleaned with benodine,applied triple antibiotic to cuts. That's a scary virus,its still easy to have mishaps,resulting in wounds. Hopefully no one contracts this virus. If I saw swelling or redness would have gone direct to ER.
 
Larry, I am glad you took precautions--and did not have any problems. As Brent noted there are literally millions of exposures, and only a hand full of cases. However precaution is always good. Also V. Vulnificus is not a virus. It is a form of bacteria--there is quite a bit of difference.
 
One precaution I started taking is to wear gloves (leather or thicker rubber type) if practical when doing tasks aboard. For example, when anchoring, when breaking out the tools, etc. The goal being to help avoid getting cuts or scrapes on my hands. I don't always remember to don them, but I try.

I started this some years ago - before I knew much about the particular bacteria we're discussing - when I was in the tropics. A woman I knew on another boat just slightly abraded her hand on a dockline and ended up with a nasty case of cellulitis (which she eventually had to go to a larger city to get taken care of; in the meantime she had to limit her swimming and was sort of "one-handed" aboard). Compared to up north (where I'm from) everything (even if no particular infection) seems to take a longer time to heal in the tropics, and I wanted to be able to go in swimming without worrying about an existing cut. I've just continued the habit. Same thing with shoes/sandals/water shoes - something to protect my feet.

I still get some (inevitable) cuts, bruises, and bumps, but it is fewer than before I started making a habit of wearing gloves.

Sunbeam

PS: I also keep disposable nitrile gloves handy for fueling and porta-potti emptying, although they're obviously not as protective against harder objects - they still help though.
 
For line handling, gloves are a good idea if they are a snug fit. Floppy, loose ones may lead to a snag in a running line, etc. Think bicycle gloves, but with complete finger protection.

The nitrile gloves mentioned, in the thin "exam glove" version, give quick protection against gasoline, and similar solvents, etc., but thicker ones are advised if you are going to do extended work. It is difficult to get a tight, flexible fit in a thicker nitrile glove, unfortunately. I sometimes double glove with the thin ones and call it good. We buy 'em by the box ... 100 pairs for five bucks, I think.
 
a new case reported today in Ocala

This patient was immuno compromised and went for medical care, and he is a vet, too

local man, 71, hospitalized with Vibrio vulnificus bacterial infection
By Jim Ross
City editor
Published: Monday, October 28, 2013 at 1:12 p.m.
Last Modified: Monday, October 28, 2013 at 1:12 p.m.

Bruce D. Rumans — 71 years old, retired Air Force man, one-time gunner on a B-52D, diabetic, heart stent recipient, Factor V blood disorder sufferer — has finally met his match.
Facts
Tips for preventing Vibrio vulnificus infection

• Do not eat raw oysters or other raw shellfish.
• Cook shellfish (oysters, clams, mussels) thoroughly.
• For shellfish in the shell, either boil until the shells open and continue boiling for 5 more minutes or steam until the shells open and then continue cooking for 9 more minutes. Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil at least 10 minutes at 375 degrees.
• Avoid cross-contamination of cooked seafood and other foods with raw seafood and juices from raw seafood.
• Eat shellfish promptly after cooking and refrigerate leftovers.
• Avoid exposure of open wounds or broken skin to warm salt or brackish water, or to raw shellfish harvested from such waters.
• Wear protective clothing, such as gloves, when handling raw shellfish.

Source: Florida Department of Health

Rumans has been hospitalized or in a rehab center for the past three months, victim of Vibrio vulnificus, a wicked bacterium.

Rumans went fishing on July 30 near Tarpon Springs. He was in the Gulf of Mexico, up to his knees, for a bit.

Afterward he was in pain with flu-like symptoms and had a blister-like sore on his right ankle.

He was admitted to Ocala Regional Medical Center on Aug. 2 and has been in some kind of medical facility ever since. The diagnosis was immediate.

Before this, despite other obstacles, “he was completely active. All he wanted to do was fish,” said Rumans’ daughter, Lissa Baker. She lives in Lakeland but is spending a lot of time in Ocala these days caring for her father.

On Monday he was at Kindred Hospital Ocala, which is a transitional care facility for patients who need extended recovery time.

Doctors have removed his right big toe and removed the skin from under his right knee down to his ankle.

Rumans couldn’t be interviewed for this story. He breathes with the assistance of a ventilator and doctors have inserted a tracheostomy tube.

“Vibrio vulnificus is a bacterium in the same family as those that cause cholera and Vibrio parahaemolyticus. It normally lives in warm seawater and is part of a group of vibrios that are called ‘halophilic’ because they require salt,” the federal Centers for Disease Control and Prevention explains on its website.

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